Reductions in Substance Use Associated With Improved Viral Outcomes in People Living With HIV

Of the ~1 million people living with HIV (PLWH) in the US, many report the use of illicit substances. This longitudinal cohort study assessed the impact of reduced use of: illicit opioids, methamphetamine/crystal, cocaine/crack, and cannabis—whether or not abstinence was achieved—on viral suppression among PLWH with substance use. The data sources were from research studies of people with HIV at HIV center of excellence primary care clinics, people using opioids around Washington, DC, people leaving jail or prison in Illinois and DC, and males with injection drug use in Vietnam. Multivariable models were used to examine the impact on viral suppression and of relative effect size reductions in viral load of decreasing the use of each substance and of abstinence.

• Abstinence was associated with higher odds of viral suppression (odds ratio [OR], 1.4–2.2) and lower relative viral load (ranging 21–42% by substance) for all 4 substance categories.
• Reduced frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with viral load suppression (OR, 2.2 and 1.6, respectively).
• Reduced frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with lower relative viral load (47% and 38%, respectively).

Comments: This observational study confirms prior findings that abstinence from illicit substance use among PLWH is associated with viral suppression, but adds to the growing harm reduction literature that reductions in substance use, even in the absence of abstinence, also have an positive impact on viral suppression.

Jeanette M. Tetrault, MD

Reference: Nance RM, Trejo MEP, Whitney BM, et al. Impact of abstinence and of reducing illicit drug use without abstinence on HIV viral load. Clin Infect Dis. 2019 [Epub ahead of print]. doi: 10.1093/cid/ciz299.